Restriction - WHY can it vary so much?? - re-post
Remember, the band is meant Primarily to dim hunger between meals, NOT "MAKE" us stop eating. If we eat until the band MAKES us stop, we have OVEReaten.
See Dr Simpson's "food quiz" here:
http://drsimpson.net/weight-loss/Lap-band-tests/portion-size /Lap-band-portion-size.htm
-----------------------------------------------------
Restriction - WHY can it vary so much??
Restriction can normally vary a lot, but there are things to know and
do to minimize the variation, so we have a more predictable and
helpful fill.
these are the things that commonly cause restriction changes, and
things that help.
The fill level itself does not change, of course, but the surrounding
tissues and stoma itself changes, so we can FEEL tighter or looser.
1. Stress - we need to learn very good stress control techniques.
Stress can wreak havoc with restriction. We'll always have stress in
our lives and cannot change that, but we CAN change the way we deal
with it. Guided Imagery was extremely sucessful for me here, and
meditation, relaxation technques, exercise, and more can also be
very effective. THis all is part of the needed "lifestyle changes"
we mention so often. We teach stress control techniques in the
Bandster Success CD's, and our therapists also should be teaching this to us. It's good for all areas of living, not just the Band issues.
2. dehydration - getting in the 80-100 oz a day we need minimizes
restriction variation. dehydration is a VERY common cause of
restriction that varies more than normal. Sipping all day long also
minimizes restriction variation, and is much better than drinking the
same amount total per day, but in only a few drinking sessions. Regular sipping as opposed to drinking a lot at once, also helps stabilize blood pressure, kidney function, heart rate, and more.
3. TOM - during and before our menstrual periods, the fluid retention
adds pressure and swelling to the areas
around the stoma. never get more fill the week before or during a
period, as it is very UNlikely to be a good fill or fluoro
4. Eating good band foods is needed to have a good restriction. Good
food choices are as important to "restriction" as the fill itself! If a fill does not seem
very good (too much or too litte) the best way to tell is to test it
with a good band meal - 3-4 oz solid protein and 1/2 cup or so of
veggies. No other foods tell a thing, unless we are so tight we can
barely get a thing down. Then it's clear we are too tight!
The band only works with solid protein and other more solid food. If
we are eating soft foods and liquids, do not expect adequate - if
any - restriction. Test a fill only with solid protein. also, remember that the goal of the band is not to feel restriction. it is simply to place mild pressure on the vagus nerve so we feel satisfied wirth a small meal and have dimmed hunger between meals.
5. Medications commonly cause stoma irritation and swelling. be sure
you're following the bandster rules about all meds smaller than an
aspirin or liquid meds, especially antibiotics. It is OUR
rsponsibility to
remember to ask for small, liquid, chewable, or break-able meds.
I suggest notifying all your docs an pharmacists to "flag" your chart
with this need. but still, YOU must check the med before you leave
the pharmacy. And don't think that if you can swallow meds, or if you
don't have immediate problems you're "getting away" with big meds.
they do NOT get thru, sit against the stoma until they eventually
dissolve, and cause irritation. the irritation can accumulate
and "suddenly" a week or two later we can swell so we can barely
drink - or swell closed altogether. don't take chances! take meds
correctly! It's much easier and wiser to prevent band /stomach
trouble than to pay the price of trouble that has already occurred.
One exception to this rule is glucophage. It is a very large pill and cannot be cut safely. Thankfully, it is also NOT irritating to the stoma, so can be safely swallowed with hot liquid, and will dossolve and go thru ok.
6. Any vomiting, sliming, pb's cause stoma swelling. avoid them by
learning needed eating teachniques and making good food choice! If
you have already vomitied or had trouble, go back to liquids for a meal or two, to allow the stoma to rest and heal.
7. Know the definition of a good fill vs one too much. Trying to keep
a too-tight new fill is the #1 reason for all the big band trouble,
including reflux, slips, erosions, and band loss. I believe our docs should be giving us clear written guidelines on all this, never just sending us you blindly home to fend for ourselves. See the 4 fill documents here in
the files for more information on fills.
8. fluoros are only the smallest clue to good fill. they tell ONLY
if the fill is too tight right then in the office. The normal
swelling occurs in the next 2-24 hs or so, long after you are gone.
You can still then be way too tight or even closed off
altogether, even if the fluoro looked "perfect" in the office. this
is a very impt concept to understand. FAR too many people think their
WAY too tight fill is normal, and that is what they will have to put
up with, simply because the doc said "this fluoro looks great' in the
office, but did not explain what little that means.
The primary use of a fluoro is to assess the pouch/esoophagus/ band
position or to locate the port. It really has very limited uses to
assess fills, and this is why most US docs do not routinely use
them. they are RADIATION (often right to the ovary area in women) and NO radiation is entirely safe. I never got fills with fluoros, even
though my doc wanted to do one with every single fill. I
consider this unnecessary and dangerous. I get ONE fluoro a year to
assess my band/pouch, and that it ALL. I've know some patients to get
10-15 fluoros the first year alone, with fills/unfills/ more fills.
If we suddenly get too tight and have not had a recent fill, it's a
possible danger sign. We need a fluoro to see what is going on,
unless it is VERy clear to us that one of the above things is the
cause of a too-tight fill. Sudden change in restriction can mean a
small slip, pouch dilation, or other problem.
Lots of this is covered more in depth in my Band Guide and the
other info in the files here. Lots to learn, and we're all here to
help each other do that.
c. Sandy Richards, BSN, MN
band educator
at goal > 5 yrs
(and grateful every day)
See Dr Simpson's "food quiz" here:
http://drsimpson.net/weight-loss/Lap-band-tests/portion-size /Lap-band-portion-size.htm
-----------------------------------------------------
Restriction - WHY can it vary so much??
Restriction can normally vary a lot, but there are things to know and
do to minimize the variation, so we have a more predictable and
helpful fill.
these are the things that commonly cause restriction changes, and
things that help.
The fill level itself does not change, of course, but the surrounding
tissues and stoma itself changes, so we can FEEL tighter or looser.
1. Stress - we need to learn very good stress control techniques.
Stress can wreak havoc with restriction. We'll always have stress in
our lives and cannot change that, but we CAN change the way we deal
with it. Guided Imagery was extremely sucessful for me here, and
meditation, relaxation technques, exercise, and more can also be
very effective. THis all is part of the needed "lifestyle changes"
we mention so often. We teach stress control techniques in the
Bandster Success CD's, and our therapists also should be teaching this to us. It's good for all areas of living, not just the Band issues.
2. dehydration - getting in the 80-100 oz a day we need minimizes
restriction variation. dehydration is a VERY common cause of
restriction that varies more than normal. Sipping all day long also
minimizes restriction variation, and is much better than drinking the
same amount total per day, but in only a few drinking sessions. Regular sipping as opposed to drinking a lot at once, also helps stabilize blood pressure, kidney function, heart rate, and more.
3. TOM - during and before our menstrual periods, the fluid retention
adds pressure and swelling to the areas
around the stoma. never get more fill the week before or during a
period, as it is very UNlikely to be a good fill or fluoro
4. Eating good band foods is needed to have a good restriction. Good
food choices are as important to "restriction" as the fill itself! If a fill does not seem
very good (too much or too litte) the best way to tell is to test it
with a good band meal - 3-4 oz solid protein and 1/2 cup or so of
veggies. No other foods tell a thing, unless we are so tight we can
barely get a thing down. Then it's clear we are too tight!
The band only works with solid protein and other more solid food. If
we are eating soft foods and liquids, do not expect adequate - if
any - restriction. Test a fill only with solid protein. also, remember that the goal of the band is not to feel restriction. it is simply to place mild pressure on the vagus nerve so we feel satisfied wirth a small meal and have dimmed hunger between meals.
5. Medications commonly cause stoma irritation and swelling. be sure
you're following the bandster rules about all meds smaller than an
aspirin or liquid meds, especially antibiotics. It is OUR
rsponsibility to
remember to ask for small, liquid, chewable, or break-able meds.
I suggest notifying all your docs an pharmacists to "flag" your chart
with this need. but still, YOU must check the med before you leave
the pharmacy. And don't think that if you can swallow meds, or if you
don't have immediate problems you're "getting away" with big meds.
they do NOT get thru, sit against the stoma until they eventually
dissolve, and cause irritation. the irritation can accumulate
and "suddenly" a week or two later we can swell so we can barely
drink - or swell closed altogether. don't take chances! take meds
correctly! It's much easier and wiser to prevent band /stomach
trouble than to pay the price of trouble that has already occurred.
One exception to this rule is glucophage. It is a very large pill and cannot be cut safely. Thankfully, it is also NOT irritating to the stoma, so can be safely swallowed with hot liquid, and will dossolve and go thru ok.
6. Any vomiting, sliming, pb's cause stoma swelling. avoid them by
learning needed eating teachniques and making good food choice! If
you have already vomitied or had trouble, go back to liquids for a meal or two, to allow the stoma to rest and heal.
7. Know the definition of a good fill vs one too much. Trying to keep
a too-tight new fill is the #1 reason for all the big band trouble,
including reflux, slips, erosions, and band loss. I believe our docs should be giving us clear written guidelines on all this, never just sending us you blindly home to fend for ourselves. See the 4 fill documents here in
the files for more information on fills.
8. fluoros are only the smallest clue to good fill. they tell ONLY
if the fill is too tight right then in the office. The normal
swelling occurs in the next 2-24 hs or so, long after you are gone.
You can still then be way too tight or even closed off
altogether, even if the fluoro looked "perfect" in the office. this
is a very impt concept to understand. FAR too many people think their
WAY too tight fill is normal, and that is what they will have to put
up with, simply because the doc said "this fluoro looks great' in the
office, but did not explain what little that means.
The primary use of a fluoro is to assess the pouch/esoophagus/ band
position or to locate the port. It really has very limited uses to
assess fills, and this is why most US docs do not routinely use
them. they are RADIATION (often right to the ovary area in women) and NO radiation is entirely safe. I never got fills with fluoros, even
though my doc wanted to do one with every single fill. I
consider this unnecessary and dangerous. I get ONE fluoro a year to
assess my band/pouch, and that it ALL. I've know some patients to get
10-15 fluoros the first year alone, with fills/unfills/ more fills.
If we suddenly get too tight and have not had a recent fill, it's a
possible danger sign. We need a fluoro to see what is going on,
unless it is VERy clear to us that one of the above things is the
cause of a too-tight fill. Sudden change in restriction can mean a
small slip, pouch dilation, or other problem.
Lots of this is covered more in depth in my Band Guide and the
other info in the files here. Lots to learn, and we're all here to
help each other do that.
c. Sandy Richards, BSN, MN
band educator
at goal > 5 yrs
(and grateful every day)
DISCLAIMER: Any suggestions or comments are not intended as medical advice, but only as general information. Please always contact your own surgeon or his staff for any specific problems or concerns you are having. Although I have many years as a medical professional and band educator, I offer suggestions here only as an experienced Bandster.
Very good post Sandy. Thank you for your efforts to educate us. I know I appreciate it and I'm sure others do as well. The more knowledge we have about our bands the better our journey will be, and to assure us of long term weight control stability.
Brenda C.
Brenda C.
Changed Goal Weight after Doctor's suggestion to 170 lbs. Height 5'7"
**Had a 17 lb gain after being bad and entertaining my old friend "Sweets"
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